A 56-year-old man with supraglottitis required a tracheostomy under local anaesthetic on presentation to hospital three days ago.
Since that time, he has been in the Intensive Care Unit receiving antibiotics and dexamethasone.
Overnight the anaesthetic registrar was asked to see the man regarding some minor neck swelling. This was managed conservatively. This morning the man has been restless and has completely dislodged his tracheostomy.
You are called as the duty anaesthetist to assist the junior ICU registrar.
As you arrive into the ICU bay this is how the patient appears:
He is moving around the bed trying to get himself comfortable. His observations as they appear on the ICU monitor are:
RR 26
SaO2 90% on Oxygen 10l/min
BP 100/52 mmHg
HR 125 bpm
Sections covered in this viva
Initial assessment and managementProgressive hypoxia post re-establishment of airwayManagement of intercostal catheter with continuous air leak